Contract Pharmacy Details

RITE AID DRUG PALACE, INC.
FQHCLA334 NEW YORK CITY HEALTH AND HOSPITALS CORPORATION

Covered Entity Details

Entity Name

NEW YORK CITY HEALTH AND HOSPITALS CORPORATION

Subdivision Name

Washington Heights

Type

Health Center Program Look-Alike

340B ID

FQHCLA334

Entity Address

600 W 168th St
New York, NY 10032-3702

Grant Number

LALCS00169

Participating Start Date

7/1/2015

Last Recertification Date

1/31/2017

Entity Termination Date

4/1/2018

Pharmacy Details

Pharmacy Name

RITE AID DRUG PALACE, INC.

Pharmacy Address

RITE AID #1711
408 GRAND STREET
NEW YORK, NY 10002

Pharmacy Comments

Contract Details

Approval Date

7/19/2016

Contract Begin Date

10/1/2016

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

4/1/2018
Covered Entity Terminated

Contacts

Covered Entity Signing Official

Antonio Martin, Ececutive Vice President & Chief Operating Officier
(212) 788-3479

Contract Pharmacy Representative

Rite Aid
Alison Farrell, Vice President |Managed Care
(717) 975-5968

Signed By Date

7/19/2016

340B Drug Pricing Program Database